What are guidelines for photographic documentation of benign skin lesions?

Updated: Jan 30, 2020
  • Author: Ginard I Henry, MD; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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To take consistent photographs that document well the physical characteristics in question, some guidelines should be followed. When shooting small objects, photographs must be taken up close. If using a digital camera, select the macro setting for close shots (a camera without this function will provide inferior pictures). Nondigital cameras require a macro lens for the clearest pictures. Wide angle is needed occasionally (eg, taking pictures of the entire back of a patient who has multiple neurofibromatosis lesions).

Lighting is critical in all photography, and skin lesions are no exception. What is captured by the camera can differ dramatically, depending on the lighting source. The best approach is to take photographs of the same lesions using multiple lighting sources. One should attempt to photograph each lesion in question using a direct light flash (the built-in camera flash or an attached ring flash); natural light (if available); and indirect light (light angled to the skin lesion not directly in front or overhead). To accomplish this, first take a photograph without examination light (just camera flash); second, take a photograph with the camera flash disabled; and third, take a photograph with camera flash on but examination light directed at the lesions from the side. This gives a wide range of appearances of the lesions, which highlight different characteristics and allow better future comparison.

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